Note: This chart does not supersede clinical judgment.
If SCr is increased >50% above baseline, increase the standard leucovorin dose to 100 mg/m2 IV every 3 hours, then adjust according to methotrexate levels.
Methotrexate level at 24 to 35 hours:
Methotrexate Level (µM/L)
Leucovorin dosing
>100
1,000 mg/m2 IV every 6 hours
>10 to <100
100 mg/m2 IV every 3 hours
~1 to 10
10 mg/m2 IV 6 hours
Methotrexate level at 36 to 71 hours:
Methotrexate Level (µM/L)
Leucovorin dosing
>100
1,000 mg/m2 IV every 6 hours
>10 to <100
100 mg/m2 IV every 3 hours
~1 to 10
100 mg/m2 IV every 6 hours
Methotrexate level at 72+ hours:
Methotrexate Level (µM/L)
Leucovorin dosing
>10
100 to 1,000 mg/m2 IV every 3 hours
~1 to 10
10 mg/m2 to 100 mg/m2 IV every 3 hours
~0.1 to 1
10 mg/m2 IV every 6 hours
Generally, leucovorin can be discontinued when methotrexate levels are < 0.1.
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Note: This chart does not supersede clinical judgment.
If SCr is increased >50% above baseline, increase the standard leucovorin dose to 100 mg/m2 IV every 3 hours, then adjust according to methotrexate levels.
Methotrexate level at 24 to 35 hours:
Methotrexate Level (µM/L)
Leucovorin dosing
>100
1,000 mg/m2 IV every 6 hours
>10 to <100
100 mg/m2 IV every 3 hours
~1 to 10
10 mg/m2 IV 6 hours
Methotrexate level at 36 to 71 hours:
Methotrexate Level (µM/L)
Leucovorin dosing
>100
1,000 mg/m2 IV every 6 hours
>10 to <100
100 mg/m2 IV every 3 hours
~1 to 10
100 mg/m2 IV every 6 hours
Methotrexate level at 72+ hours:
Methotrexate Level (µM/L)
Leucovorin dosing
>10
100 to 1,000 mg/m2 IV every 3 hours
~1 to 10
10 mg/m2 to 100 mg/m2 IV every 3 hours
~0.1 to 1
10 mg/m2 IV every 6 hours
Generally, leucovorin can be discontinued when methotrexate levels are < 0.1.